Safety catch

Michael Rawlins is to head the new National Institute for Clinical Excellence, but some feel that the appointment of a man 'used to working in a straitjacket' at the Committee on Safety of Medicines does not bode well.

Professor Michael Rawlins may be a low-profile figure to head the National Institute for Clinical Excellence, but he is no stranger to controversy or to upsetting GPs.

Not that this is a history he will be keen to play up in his new job.

As chair of the Committee on Safety of Medicines, Professor Rawlins was forced into a humbling public apology when GPs first learned about a possible contraceptive pill scare through media reports rather than official channels.

The same incident - which furious GPs said meant they were left unable to advise anxious patients - provoked anger among drug companies not implicated in the scare, and was even blamed for an increase in the birth rate.

It is the sort of five-minute furore that it is easy to foresee engulfing a body such as NICE when it sets out on its mission to set standards and disseminate guidance throughout the NHS.

But by all accounts, it is not the sort of incident usually associated with Professor Rawlins' ultra-safe pair of hands. The fact that it has not recurred at the CSM in the four years since his apology may mean that NICE's£20,925-a-year part-time chair brings with him some important lessons for the new body.

Certainly, Professor Rawlins' career and background speak of solidity and reliability rather than risk-taking and excitement.

The son of a clergyman, he married in 1963 and has three daughters. He lives in one of Newcastle's more comfortable suburbs and has a second seaside home in Northumberland, where he is a member of the local golf club.

Respected internationally as a clinical pharmacologist, he is by any measure well ensconced in the medical establishment. It is not hard to foresee that he will collect a gong of some kind - and maybe an upgraded gong if all goes well at NICE - when he hangs up his white coat.

Announcing Professor Rawlins' appointment two weeks ago, health secretary Frank Dobson predicted that he would be 'an excellent ambassador' for quality, cost and clinical effectiveness. He also praised Professor Rawlins as 'a clinical pharmacologist of world renown', whose knowledge and expertise would be a valuable asset.

It is an assessment which Joe Collier, editor of the Drug and Therapeutics Bulletin and professor of medical policy at St George's Hospital medical school, endorses. 'I am a great admirer of what he does,' he says.

Professor Collier believes the appointment signals that NICE will focus initially on the drug side of its remit. But despite his admiration for Professor Rawlins' professional abilities, he has some reservations.

'He is used to working in a straitjacket at the CSM, and I think that is rather a bad omen,' says Professor Collier. 'I rather hoped NICE would be about open government, but I fear it may not be quite like that.'

Whether by accident or design, in breaking the news of Professor Rawlins' appointment, Mr Dobson went on to raise doubts about how long he would hold the job - doubts Professor Rawlins himself did nothing to dispel.

With Mr Dobson hoping that the new chair would 'productively steer NICE through its first few years', Professor Rawlins reinforced the message that he would 'hope to guide the institute through its first few years'.

The conclusion some draw is that this is an interim appointment until a weightier public figure can be found - and rumours persist that others were approached but turned the job down.

The names of Naren Patel, former president of the Royal College of Obstetricians and Gynaecologists, and Deirdre Hine, former chief medical officer for Wales, have been whispered. Both strongly deny having been approached.

And Professor Collier says that even if Professor Rawlins' tenure is short - 'and there is no reason why it should be' - as the first chair of NICE, 'he will set the ground rules and the tenor of the whole organisation'.

It will not be easy. Dr Hine thinks Professor Rawlins 'an entirely appropriate choice', but predicts that he will have a tough time ahead of him. His two key tasks, she says, will be to draw together the work currently under way, and to try to meet some of the high expectations politicians and professionals alike have of NICE.

He will also be under pressure to take far more account of cost implications than he has had to at the CSM. NHS Confederation chief executive Stephen Thornton says NICE's recommendations must be 'realistic and achievable'.

'It is important to remember that trusts and not clinicians will be responsible for clinical governance,' he says. NICE should 'support, empower and inform' trust boards.

Mr Thornton says there should be communications expertise on the board of NICE to ensure that it makes an impact. And he adds: 'We would anticipate a senior management input into the running of NICE.'

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